Epidemiological Profile of HIV/AIDS in Minnesota

Ryan White Services and Unmet Need:
Ryan White Services
in Minnesota

This section of the profile provides a description of people who use the Ryan White HIV/AIDS Program services in Minnesota, both within the TGA (Part A and Part B) and Greater Minnesota (Part B), and quantifies the unmet need for primary medical care.

Data Sources

The data presented in this section comes primarily from two sources, the enhanced HIV/AIDS Reporting System (eHARS) and the Minnesota CAREWare system used by all agencies providing Part A, Part B, ADAP and state-funded HIV services.

Since almost all Ryan White services are dependent on financial eligibility, it should not be expected that everyone living with HIV/AIDS in Minnesota would be eligible and/or receiving Ryan White services. Therefore, surveillance data should not be used as the standard by which services are measured, but as an additional piece of the puzzle in describing HIV/AIDS care in Minnesota.

Overview of Ryan White in Minnesota

Comparison of Epi and Utilization Data

The number of clients utilizing Ryan White services has steadily grown from 1,771 in 1996 to 4,117 in 2014. This is compared to 7,988 people assumed to be living with HIV in Minnesota that are in surveillance. Over the past three years, several of the funded services have seen increases in the number of people being served.

Gender

Males comprise the majority of those living with HIV/AIDS in Minnesota, accounting for 76% of all cases. A similar distribution is seen among those receiving services, with males accounting for 70% of clients and females accounting for 29%. Transgender persons make up about 1% of those receiving services and 0.5% of all cases in surveillance.

Age

Persons ages 40-55 account for the most (47%) of the people receiving Ryan White services in 2014. Adolescents and young adults (ages 13–24) account for 5% of those receiving services. The age distribution of those receiving services is similar to those living with HIV/AIDS according to surveillance. People ages 40-55 account for 50% of those living with HIV/AIDS and adolescents and young adults account for 4% (data not shown).

Mode of Exposure

There are substantial differences in the mode of exposure distribution between people receiving Ryan White Services and the mode of exposure distribution of everyone living with HIV in Minnesota who are in surveillance.

While MSM account for 51% of those living with HIV/AIDS in surveillance, they only account for 44% in Ryan White clients. People with a risk of heterosexual contact make up a greater proportion of Ryan White clients than in surveillance, accounting for 38% of Ryan White clients and 22% of people in surveillance.

Race/Ethnicity

There are differences in the racial/ethnic distribution between people receiving Ryan White Services and everyone living with HIV in Minnesota who is in surveillance. While white people account for half of the people living with HIV/AIDS in Minnesota, they account for 40% of the people receiving Ryan White services. People of color account for the other half of the people living with HIV/AIDS in Minnesota, and 60% of those receiving Ryan White Services.

Geography

The table below shows that the proportion of HIV positive people receiving services is greater the TGA than in Greater Minnesota. Additionally, based on the number of people served by Ryan White, the majority of people accessing Ryan White services live in the TGA (86%) compared to 13% in Greater Minnesota. In addition, 1% of people receiving services have unknown counties of residence, and less than 1% reside in other states.

Number of People Receiving Ryan White CARE Act Services and Living Cases of HIV/AIDS, Minnesota 2014

Number Receiving Services*

Number in SurveillanceŦ

Percentage Receiving Services

Greater MN

541

1,128

48%

13-County TGA

3,529

6,832

52%

* Includes 10 cases from Pierce and St. Croix counties, does not include 43 cases with unknown residence.
Ŧ Does not include 43 cases with unknown residence.

Services Received in 2014

In 2014, Medical Case Management was the most utilized service, with 2,960 clients (72% of clients) accessing case management services. Medical Transportation Services was the next most utilized service with 1,517 clients (37% of clients), followed by the Meal Services with 1,442 clients served (35% of clients), AIDS Pharmaceutical Assistance Program (ADAP) with 1,311 clients (32% of clients), and emergency financial assistance with 1,044 clients (25% of clients). The next most used services were Case Management (non-medical), Outpatient/Ambulatory Care, and Oral Health Care with 871, 773, and 622 clients, respectively.

Characterizing Unmet Need for Primary Care Among HIV Positive People

The definition of unmet need for primary medical care is: “An individual with HIV or AIDS is considered to have an unmet need for care (or to be out of care) when there is no evidence that s/he has received any of the following three components of HIV primary medical care during a defined 12-month time frame: (1) viral load testing, (2) CD4 count, or (3) provision of anti-retroviral therapy (ART).” (1)(1) HRSA/HAB definition of unmet need

MDH calculated an estimate of unmet need using data in eHARS to determine the number of people living with HIV/AIDS as of December 31, 2014 and how many of those individuals had received a CD4 or viral load test in 2014.

As of December 31, 2014 there were 7,988 persons living with HIV/AIDS in Minnesota. Using the methodology described above, we are able to estimate that of those, the number not receiving primary medical care for their HIV is 2,149 or 27% of people living with HIV/AIDS in Minnesota. The table below shows the number of people living with HIV/AIDS who are in and out of care by race, gender and mode of exposure.

Demographic Characteristics of Out of Care PLWHA in Minnesota, 2014

Number
In Surveillance

Number
In Care

Number
Out of Care

Percent
Out of Care

Race*

White, not Hispanic

3,977

3,065

912

23%

Black, not Hispanic

2,819

1,948

871

31%

African American

1,719

1,177

542

32%

African-born

1,100

771

329

30%

Hispanic

716

459

257

36%

American Indian

121

96

25

21%

Asian/Pacific Islander

153

117

36

24%

Multiple Races

180

147

33

18%

Gender**

Male

6,108

4,443

1,665

27%

Female

1,880

1,396

484

26%

Mode of Exposure

MSM

4,046

3,012

1,034

26%

IDU

429

283

146

34%

MSM/IDU

405

307

98

24%

Heterosexual contact

1,775

1,316

459

26%

Mother with HIV

103

90

13

13%

Other/hemophilia/blood transfusion

34

27

7

21%

Unspecified risk

1,196

804

392

33%

Total

7,988

5,839

2,149

27%

*Excludes individuals of unknown race
** Does not include transgender individuals